Unknown Individual – Family Medicine Physician, NPI 1588770879
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
200, 5th Street North, Downtown, Saint Petersburg, Pinellas County, Florida, 33701, United States
ST. PETERSBURG, FL 337114511
Phone: (727) 824-0780
Fax: (727) 568-6011
Type: Mailing
2816, 54th Avenue South, Lakewood Estates, Saint Petersburg, Pinellas County, Florida, 33712, United States
ST PETERSBURG, FL 337124610
Phone: (727) 867-8641
Fax: (727) 867-6795
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 33711)
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